HomeMy WebLinkAboutContracts & Agreements_15-2026PUBLIC WORK CONSTRUCTION CONTRACT
This Public Work Construction contract ("Contract") is made and entered into this 17' day of
February, 2026, by and between the City of Redlands, a municipal corporation, organized and existing
under the laws of the State of California (hereinafter "City"), and MCC Pipeline, Inc. (hereinafter
"Contractor"). City and Contractor are sometimes individually referred to herein as a "Party" and,
together, as the "Parties."
In consideration of the mutual promises contained herein, City and Contractor agree as follows:
1. SCOPE OF WORK: Contractor shall furnish all materials and will perform all of the work for
the following: 2025 CIP Water Pipeline Replacement Project, Project No. 501068, complete all
items as required by the Contract Documents (as herein defined) and Specifications for City's
2025 CIP Water Pipeline Replacement Project, Project No. 501068 (the "Work").
2. CONTRACT SUM: City shall pay Contractor the sum of Four Million Three Thousand Five
Hundred Ninety -Five dollars ($4,003,595) as consideration for its performance of the Work in
accordance with the terms and conditions set forth in the Contract Documents. Pursuant to Public
Contract Code Section 22300, Contractor has the option to deposit securities with an escrow agent
as a substitute for retention of earnings required to be withheld by City pursuant to an escrow
agreement as set forth in Public Contract Code section 22300.
3. TIME FOR COMPLETION: The Work shall be completed within one hundred (100) working
day(s) as defined in Section 1-2 of the Standard Specifications for Public Works Construction
"Greenbook" from and after the date of City's issuance of a Notice to Proceed to Contractor.
4. LIQUIDATED DAMAGES: Contractor's failure to complete the Work within the time allowed
will result in damages being sustained by City. Such damages are, and will continue to be,
impracticable and extremely difficult to determine. Accordingly, Contractor shall pay to City, or
have withheld from monies due to Contractor, the sum of Five Hundred dollars ($500) for each
working day as defined in Section 1-2 of the Standard Specifications for Public Works
Construction "Greenbook" in excess of the specified time for completion of the Work. Execution
of this Contract shall constitute agreement by City and Contractor that Five Hundred dollars
($500) per day is the estimated damage to City caused by the failure of Contractor to complete the
work within "the allowed time. Such sum is liquidated damages and shall not be construed as a
penalty, and may be deducted from payments due Contractor if such delay occurs.
5. CONTRACT DOCUMENTS: This Contract incorporates by reference the following: Notice
Inviting Bids, Instructions to Bidders, Contractor's Proposal, Bid Bond, Agreement, Performance
Bond, Labor and Material Bond, Plans, General Conditions, Special Provisions and Specifications,
and any addenda thereto (collectively, the "Contract Documents").
6. ATTORNEYS' FEES: In the event any action is commenced to enforce or interpret the terms or
conditions of this Contract, or the Contract Documents, the prevailing Party in such action, in
addition to any costs and other relief, shall be entitled to recover its reasonable attorneys' fees,
including fees for use of in-house counsel by a Party.
7. RESOLUTION OF CONSTRUCTION CLAIMS: Claims by Contractor in the amount of
Three Hundred Seventy -Five Thousand dollars ($375,000) or less shall be made by Contractor and
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processed by the City pursuant to the provisions of Part 3, Chapter 1, Article 1.5 of the Public
Contract Code (commencing with Section 20104). All claims shall be in writing and include the
documents necessary to substantiate the claim. Nothing in subdivision (a) of Public Contract Code
Section 20104.2 shall extend the time limit or supersede the notice requirements provided in this
case from filing claims by Contractor.
8. ELIGIBILITY OF CONTRACTOR/SUBCONTRACTOR: Contractor and all of its
subcontractors shall abide by California Public Contract Code, Section 6109, and California Labor
Code Sections 1777.1 and/or 1777.7, and certify that they are not debarred and are eligible to work
on this project.
9. ASSIGNMENT OF AGREEMENT: No assignment by a Party of any rights or interests under
this Contract shall be binding on another Party without the written consent of the Party sought to
be bound.
10. SUCCESSORS AND ASSIGNS: City and Contractor each binds itself and their respective
successors and assigns in respect to all covenants, agreements, and obligations contained in the
Contract Documents.
11. SEVERABILITY: Any provision or part of the Contract Documents held to be void or
unenforceable under any law or regulation shall be deemed stricken, and all remaining provisions
shall continue to be valid and binding upon City and Contractor.
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INWITNESS WHEREOF, the Parties hereto have executed this Contract the day and year first
written above.
CITY OF REDLANDS
(SEAL)
By:
Mario Saucedo, Mayor
ATTEST:
Ka-Ac Donaldson, City Clerk
(SEAL)
MCC Pipeline, Inc.
Name of Contractor
By:
Si ture thorized Agent
President
Title
993248
Contractor's License No.
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THE FINAL PREMIUM IS This bond was issued in two (2) original counterparts
PREDICATED ON THE Bond No. GM255879
FINAL CONTRACT AMOUNT Premium: $30,975.00
FAITHFUL PERFORMANCE BOND
Whereas, the City of Redlands ("City"), State of California, slid MCC Pipeline, Inc.
(hereinafter designated as "Principal") have entered into an agreement dated February 17, 2026,
("Agreement") whereby Principal agrees to install and complete certain public improvements (the
"Work"), which said Agreement is identified as 2025 CIP Water Pipeline Replacement Project,
Project No. 501068 and is hereby referred to and made a part hereof; and
Whereas, said Principal is required under the terns of the Agreement to furnish a bond for
the faithful performance of the Work, now, therefore, we, the Principal and,
Great Midwest Insurance Company as Surety, are held and firmly bound unto the City in the penal
sum of Four Million Three Thousand Five Hundred Ninety -Five dollars ($4,003,595) lawful money
of the United States, for the payment of which sum we bind ourselves, and our heirs, successors,
executors and administrators, jointly and severally, firmly by these presents.
The condition of this obligation is such that if the above bounded Principal, his or its heirs,
executors, administrators, successors or assigns, shall in all things stand to and abide by, and well
and truly keep and perform the covenants, conditions and provisions in the Agreement and any
alteration thereof made as therein provided, on his or its part, to be kept and performed at the time
and in the manner therein specified, and in all respects according to their true intent and meaning,
and shall faithfully fulfill the one-year guarantee of all materials and workmanship, and shall
defend, indenanify and save harmless the City and its elected officials, officers, agents and
employees, as therein stipulated, then this obligation shall become null and void; otherwise it shall
be and remain in full force and effect.
As a part of the obligation secured hereby and in addition to the face amount specified
therefor, there shall be included costs and reasonable expenses and fees, including reasonable
attorneys' fees, incurred by the City in successfully enforcing such obligations, all to be taxed as
costs and included in the judgment rendered.
As a condition precedent to the satisfactory completion of the Work, the above obligation
shall hold good for a period of one (1) year or longer if required by the Agreement after the
acceptance of the work by the City, during which time if the Principal shall fail to make full,
complete, and satisfactory repair and replacements and totally protect the City from loss or damage
made evident during this period from the date of completion of the Work, and resulting from or
caused by defective materials or faulty workmanship, the above obligation in penal sum thereof
shall remain in full force and effect. The obligations of Surety hereunder shall continue so long as
any obligation of the Principal remains.
Whenever the Principal shall be, and is declared by the City to be, in default under the
Agreement, the City having performed the City obligations thereunder, the Surety shall promptly
remedy the default, or shall promptly, at the City's option:
Complete the Work in accordance with its terms and conditions; or
2. Obtain a bid or bids for completing the Work in accordance with its terms and
conditions, and upon determination by Surety of the lowest responsive and responsible bidder,
arrange for a contract between such bidder and the City, and make available as work progresses
sufficient funds to pay the cost of completion of the Work less the balance of the Agreement price,
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but not exceeding, including other costs and damages for which Surety may be liable hereunder, the
amount set forth above. The term "balance of the Agreement price," as used in this paragraph, shall
mean the total amount payable to the Principal by the City under the Agreement and any
modifications thereto, less the amount previously properly paid by the City to the Principal.
Surety expressly agrees that the City may reject any contractor or subcontractor which may
be proposed by Surety in fulfillment of its obligations in the event of default by the Principal.
Surety shall not utilize the Principal in completing the Work nor shall Surety accept a bid
from the Principal for completion of the Work if the City, when declaring the Principal in default,
notifies Surety of the City's objection to the Principal's further participation in the completion of
the Work.
No right of action shall accrue on the bond to or for the use of any person or corporation
other than the City named herein or the successors or assigns of the City. Any suit under this bond
must be instituted within the applicable statute of limitations period.
The said Surety, for value received, hereby stipulates and agrees that no change, extension
of time, alteration or addition to the terms of the Agreement or to the work to be performed
thereunder or the Specifications accompanying the same shall in any way affect its obligations on
this bond, and it does hereby waive notice of any such change, extension of time, alteration or
addition to the terms of the Agreement or to the work or to the specifications.
No final settlement between the City and the Principal shall abridge the right of any
beneficiary hereunder whose claim may be unsatisfied.
The Principal and Surety agree that if the City is required to engage the services of any
attorney in connection with the enforcement of this bond, each shall pay the City's reasonable
attorneys' fees incurred, with or without suit, in addition to the above sum.
In witness whereof, this instrument has been duly executed by the Principal and Surety
above named, on February 10th , 2026.
(SEAL)
MCC P' eline, Inc.
tractor)
(Signature)
(Sea[ and Notarial Acknowledgment of
Surety)
(SEAL)
C3 atAidw9A Insur nce Aompa y
Sur )
BY:
(Signature) 5haunna Rozelle Ostrom
Attomey-in-Fact
Address: 25622 Orchard Rim Lane
Lake Forest, CA 92630
Telephone ( 949 )804-3836
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ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Orange )
On February 10th, 2026 before me, Laura Conlon, Notary Public
(insert name and title of the officer)
personally appeared Shaunna Rozelle Ostrom
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by hislherltheir signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal. LAURACONLON
COMM. #2521.232 n
Notary Pubiio-California a
'} a ORANGE COUNTY a
J I J My Comm. Expires Jun 20, 2029
Signature �' '�J"� (Seal)
Laura Conlon
Bond No. GM255879
POWER OF ATTORNEY
Great Midwest Insurance Company
KNOW ALL MEN BY THESE PRESENTS, that GREAT MIDWEST INSURANCE COMPANY a Texas Cc oration, with its principal of
iri, TX, does hereby constitute and appoint: Ar�uro AY ala, Daniel Huckabay, Dwight Reill S(launna Rozelle Ostrom, Frank Morones,
0. Stung, Ben Stung, R. Nappi, Benjamin Wo fe, CfYelsea Liberatore, Adrian Langrell, Nylagdalena R. Wolfe
true and lawful Attorney(s)-In-Fact to make, execute, seal and deliver for, and on its behalf as surety, any and all bonds, undertakings or other
tinge obligatory in nature of a bond.
This authority is made under and by the authority of a resolution which was passed by the Board of Directors of GREAT MIDWEST
3URANCE COMPANY, on the 1e1 day of April, 2025 as follows:
Resolved, that the President, or any officer, be and hereby is, authorized to appoint and empower any representative of the Company
person or persons as Attorney -In -Fact to execute on behalf of the Company any bonds, undertakings, policies, contracts of indemnity or off
3s obligatory in nature of a bond not to exceed One -Hundred Million dollars ($100,000,000.00), which the Company might execute throu
ly elected officers, and affix the seal of the Company thereto. Any said execution of such documents by an Attorney -In -Fact shall be
ig upon the Company as If they had been duly executed and acknowledged by the regularly elected officers of the Company. Any Attorney -
so appointed, may be removed in the Company's sole discretion and the authority so granted may be revoked as specified in the Power
Resolved, that thesignature of the President and the seal of the Company may be affixed by electronic mail on any power of attorr
tad, and the signature of the Secretary, and the seal of the Company may be affixed by electronic mail to any certifcate of any such pot
any such power or certificate bearing such electronic signature and seal shall be valid and binding on the Company. Any such power
uted and sealed and certificate so executed and sealed shall, with respect to any bond of undertaking to which it is attached, continue to
and binding on the Company.
IN WITNESS THEREOF, GREAT MIDWEST INSURANCE COMPANY, has caused this instrument to be signed by its President, and
Seal to be ajf this Sth day of April, 2025. GREAT MIDWEST INSURANCE COMPANY
��t WSUgpNC
N
COflPtlaATESEAL � BY
Mark W. Haushill
00 President
ACKNOWLEDGEMENT
On this 8th day of April 2025, before me, personally came Mark W. Haushill to me known, who being duly sworn, did depose and
t he is the President of GREAT MIDWEST INSURANCE COMPANY, the corporation described in and which executed the above instrument;
executed said instrument on behalf of the corporation by authority of his office under the By-laws of said corporation.
ga : CHHIETtNABIBHOP
Sa: My Noisily ID # 131000000
t" by til'I off, FxpkesAp 4,2020
CERTIFICATE
Christina Bishop
Notary Public
I, the undersigned, Secretary of GREAT MIDWEST INSURANCE COMPANY, A Texas Insurance Company, DO HEREBY CERTIFY that
original Power ofAttomey ofwhich the foregoing is a true and correct copy, is in full force and effect and has not been revoked and the resolutions
set forth are now in force.
and Sealed at Houston, TX this 10th Day of February 2026
$�S� 1NSUggNCic
nORPORATE SEAL BY
��'�AS COflPORp�`Os,
is Any person who knowingly and with Intent to defraud any Insurance company or other person, flies and application for insurance of clai
any materially false Information, or conceals for the purpose of misleading, Information concerning any fact material thereto, commits
Insurance act, which is a crime and subjects such person to criminal and civil penalties.
THE FINAL PREMIUM IS This bond was issued in two (2) original counterparts
PREDICATED ON THE
FINAL CONTRACT AMOUNT Bond No. GM255879
LABOR AND MATERIAL BOND
Whereas, the City Council of the City of Redlands, State of California, and
MCC Pipeline, Inc. (hereinafter designated as "Principal") have entered into an agreement
(the "Agreement") whereby Principal agrees to install and complete certain designated public
improvements (the "Work"), which said agreement, dated February 17, 2026, and identified as 2025
CIP Water Pipeline Replacement Project, Project No. 501068 is hereby referred to and made a part
hereof, and
Whereas, under the terms of the Agreement, Principal is required before commencing the
performance of the Work, to file a good and sufficient Labor and Material bond with the City of
Redlands to secure the claims to which reference is made in Title 3 (commencing with Section
9550) of Part 6 of Division 4 of the Civil Code of the State of California.
Now, therefore, said Principal and the undersigned as corporate surety, are held firmly
bound unto the City and all contractors, subcontractors, laborers, material men and other persons
employed in the performance of the Agreement and referred to in the aforesaid Code of Civil
Procedure in the sum of four million three thousand five hundred ninety-five dollars ($4,003,595) for
materials furnished or labor thereon of any kind, or for amounts due under the Unemployment
Insurance Act with respect to such work or labor, that said surety will pay the same in an amount
not exceeding the amount hereinabove set forth, and also in case suit is brought upon this bond, will
pay, in addition to the face amount thereof, costs and reasonable expenses and fees, including
reasonable attorneys' fees, incurred by the City in successfully enforcing such obligation, to be
awarded and fixed by the court, and to be taxed as costs and to be included in the judgment therein
rendered.
It is hereby expressly stipulated and agreed that this bond shall insure to the benefit of any
and all persons, companies and corporations entitled to file claims under Title 3 (commencing with
Section 9550) of Part 6 of Division 4 of the Civil Code, so as to give a right of action to them or
their assigns in any suit brought upon this bond.
Should the condition of this bond be fully performed, then this obligation shall become null
and void, otherwise it shall be and remain in frill force and effect.
The surety hereby stipulates and agrees that no change, extension of time, alteration or
addition to the terms of the Agreement or the specifications accompanying the same shall in any
manner affect its obligations on this bond, and it does hereby waive notice of any such change,
extension of time, alteration or addition.
In witness whereof, this instrument has been duly executed by the Principal and surety
above named, on February I Oth , 2026.
(SEAL)
MCC Pipeline, Inc.
{f ontt etor)
li
(Signature)
(Sea] and Notarial Acknowledgement of Surety)
(SEA
G at M' est I surance Co any
BY: � � Y fty�0
(Signature) Shaunna Rozelle Ostrom
Attomey-in-Fact
Address:25622 Orchard Rim Lane
Lake Forest, CA 92630
Telephone: ( 949 ) 804-3836
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ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Orange
On February 10th, 2026 before me, Laura Conlon, Notary Public
(insert name and title of the officer)
personally appeared Shaunna Rozelle Ostrom
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand d official seal.
LAURA CONLON
m COMM.#2521232
Notary Public -California
U. p, ORANGE COUNTY IL
Ally Comm. Explreshn 20, 2029
Signature (Seal)
Laura Conlon
Bond No. GM255879
OF ATTORNEY
Great Midwest Insurance Company
KNOW ALL MEN BY THESE PRESENTS, that GREAT MIDWEST INSURANCE COMPANY a Texas Corpporation, with its principal of
m, TX, does hereby constitute and appoint: Arturo AVa+a, Daniel Huckabay, Dwight Refill , S(Taunna Raze Is Ostrom, Frank Morones,
D. Stang, Ben Stang, R. Nappi, Benjamin Wolfe, Cfia sea Liberatore, Adrian Langrell, Nylagdalena R. Wolfe
true and lawful Attorneys) -In -Fact to make, execute, seal and deliver for, and on its behalf as surety, any and all bonds, undertakings or
tings obligatory in nature of a bond.
This authority is made under and by the authority of a resolution which was passed by the Board of Directors of GREAT MIDWEST
NCE COMPANY, on the 16i day of April, 2025 as follows:
Resolved, that the President, or any officer, be and hereby is, authorized to appoint and empower any representative of the Company
person or persons as Attorney -In -Fact to execute on behalf of the Company any bonds, undertakings, policies, contracts of indemnity or otf
3s obligatory in nature of a bond not to exceed One -Hundred Million dollars ($100,000,000.00), which the Company might execute throu�.
ly elected officers, and affix the seal of the Company thereto. Any said execution of such documents by an Attorney -In -Fact shall be
ig upon the Company as If they had been duly executed and acknowledged by the regularly elected officers of the Company. Any Attorney -
so appointed, may be removed in the Company's sole discretion and the authority so granted may be revoked as specified in the Power
Resolved, that the signature of the President and the seal of the Company may be affixed by electronic mail on any power of atton
led, and the signature of the Secretary, and the seal of the Company may be affixed by electronic mail to any certificate of any such poi
any such power or certificate bearing such electronic signature and seal shall be valid and binding on the Company. Any such power
uted and sealed and certificate so executed and sealed shall, with respect to any bond of undertaking to which it is attached, continue to
and binding on the Company.
IN WITNESS THEREOF, GREAT MIDWEST INSURANCE COMPANY, has caused this instrument to be signed by its President, and
a Seal to be 4NSUflpNe this Bth day of April, 2025. GREAT MIDWEST INSURANCE COMPANY
not .--
P
N
CORPOnATE SEAL BY �^^
Mark W. Haushill
As concoA"President
ACKNOWLEDGEMENT
On this 8th day of April 2025, before me, personally came Mark W. Haushill to me known, who being duly sworn, did depose and
it he is the President of GREAT MIDWEST INSURANCE COMPANY, the corporation described in and which executed the above instrument;
executed said instrument on behalf of the corporation by authority of his office under the By-laws of said corporation.
:Rag +'l;.: CHR15TNdASI51
My Notary ID#13109M BY lfi
�:••`^i i4 2 Christina Bishop
EVIINAId:,,2.°f^"• Notary Public
CERTIFICATE
I, the undersigned, Secretary of GREAT MIDWEST INSURANCE COMPANY, A Texas Insurance Company, DO HEREBY CERTIFY that
original Power of Attorney ofwhich the foregoing is a true and correct copy, is in full force and effect and has not been revoked and the resolutions
set forth are now in force.
and Sealed at Houston, TX this loth Day of February 2026
��y{ INSUgq,t,C
CORPOnATESEAL BY,
0�
A3 OOnPo�p�\
:: Any person who knowingly and with intent to defraud any insurance company or other person, files and application for Insurance of clal
any materially false Information, or conceals for the purpose of misleading, Information concerning any fact material thereto, commits
insurance act, which is a crime and subjects such person to criminal and civil penalties.
FAA NkgIOWA I:Iam viI=1►r9
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of Calif ni
County o�
On -2) -� before me, C .�Iz
(insert name and title of the officer)(
personally appeared L V UTi
who proved to me on the basis of satisfactory evidence to be the person whose name are
subscribed to the within instrument nd acknowledged to me that he Itey executed he same in
his Ke 7t�}eir authorized capacity(i ), and that by his/j /their signature on the instrument the
person(}, or the entity upon behalf of which the person acted, exec ted the instrument.
certifyunderPENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
.�. N..M..NHq..N..
A G. Atl('MER
WITNESS my hand and official seal. Comm. # 2532309 SAN BERNAMM County
i California - Nclary Public ;
...... Comm.Expires .�.EPT.13, 2029.i
Signatur (Seal)
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of CaI nia
County of �
On Jbefore me, C :B&i�6=90j%l
(insert name and title of the officer)
personally appeared 1,IVVV1I40-t7-
who proved to me on the basis of satisfactory evidence to be the person whose name } tare
subscribed to the within instrument nd acknowledged to me that he/ It ey executed h me in
hislt eir authorized capacity(i ), and that by his/3It eir signature on the instrument the
person, or the entity upon behalf of which the personnacted, exec ted the instrument.
E certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
MN►►tM►�►p►►��•►►►iM►►q►►�
A C. ALOW40ER =
WITNESS my hand and official seal. Corm .#2532309
SM BERIVAM County M
California - Notary Public
Camm. Expires SEPT 13, 2029 t
Signature , (Seal)
WORKER'S COMPENSATION INSURANCE CERTIFICATION
Description of Contract: City of Redlands
Municipal Utilities and Engineering Department
2025 CIP Water Pipeline Replacement Project
Project No. 501068
Every employer, except the State, shall secure the payment of compensation in one or more of the
following ways:
a. By being insured against liability to pay compensation by one or more insurers duly
authorized to write compensation insurance in this State.
b. By securing from the Director of Industrial Relations, a certificate of consent to self -
insure, either as an individual employer, or as one employer in a group of employers,
which may be given upon furnishing proof satisfactory to the Director of Industrial
Relations of ability to self -insure and to pay any compensation that may become due
to his or her employees.
CHECK ONE
X I am aware of the provisions of Section 3700 of the Labor Code which requires every
employer to be insured against liability for Workers' Compensation or to undertake self-insurance
in accordance with the provisions of that Code, and I will comply with such provisions before
commencing the performance of the work and activities required or permitted under this
Agreement. (Labor Code §1861).
I affirm that at all times, in performing the work and activities required or permitted under
this Agreement, I shall not employ any person in any manner such that I become subject to the
workers' compensation laws of California. However, at any time, if I employ any person such that I
become subject to the workers' compensation laws of California, immediately I shall provide the
City with a certificate of consent to self -insure, or a certification of workers' compensation
insurance.
1 certify under penalty of perjury under the laws of the State of California that the information and
representations made in this certificate are true and correct.
Dated this loth day of February , 2026.
MCC Pipeline, Inc.
ntract ')
.w.
(Signature)
Officer
(Official Title)
(SEAL)
(Labor Code Section 1861 provides that the above certificate must be signed and filed by the Contractor with the
Owner prior to performing the work of the contract.)
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